Pulsed Low-Dose-Rate Radiation for the Treatment of Pancreatic Cancer

Inclusion Criteria

• Patients must have histologically or cytologically-confirmed pancreatic adenocarcinoma
• Patients must have non-metastatic pancreatic cancer not appropriate for immediate surgical resection. This includes the following: * Any involvement (defined as loss of fat plane on contrast computed tomography [CT]) of any of the following vessels: ** Common hepatic artery ** Superior mesenteric artery ** Celiac axis ** Superior mesenteric vein ** Portal vein ** Aorta * These criteria will be judged by the operating surgeon in conjunction with a radiologist prior to enrollment * Poor performance status not immediately conducive to radical surgery * Other clinical reasoning by the treating physicians that supports pre-operative chemoradiation
• Patients must have evaluable disease as determined by the physician
• Planned surgical resection at the time of enrollment (may be initially staged as resectable, borderline resectable, or locally-advanced/unresectable)
• Eastern Cooperative Oncology Group, or ECOG, performance status 0-2
• Absolute neutrophil count (ANC) >= 1,500/ul
• Platelets (PLT) >= 100,000/ul
• Bilirubin less than 1.5 upper limit of normal (ULN)
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3 x ULN
• Serum creatinine < 1.5 x ULN
• Prior chemotherapy allowed, but not mandatory. Patients who have undergone chemotherapy prior to participating in this study must have had a 2 week washout period at the time of signing the consent form
• Women of childbearing potential must be non-pregnant (negative pregnancy test within 72 hours prior to registration. Postmenopausal woman must have been amenorrheic and nonlactating for at least 12 months to be considered of non-childbearing potential. Men and women of child bearing potential must be willing to exercise an effective form of birth control (abstinence/contraception) while on study and for 3 months after therapy is completed
• Age >= 18 years
• Participants must sign a written informed consent and Health Insurance Portability and Accountability Act (HIPAA) consent prior to performance of study-specific procedures or assessments and must be willing to comply with treatment and follow-up

Exclusion Criteria

• Radiological or cytologically confirmed metastatic disease
• Patients who have had any prior therapy for pancreatic cancer, except chemotherapy
• Concurrent non-study chemotherapy or biologic therapy
• A history of ataxia telangiectasia or other documented history of radiation hypersensitivity
• Scleroderma or active connective tissue disease
• Active inflammatory bowel disease
• Serious, active infections requiring treatment with IV antibiotics
• Uncontrolled intercurrent illness including, but not limited to, psychiatric illness/social situations that would limit compliance with study requirements